Opinion: This Fianna Fáil Government deserves credit for reversing another's mistake, says Noel Whelan
ONE OF the last things a Minister for Finance worries about before a budget is which of the proposals being announced is most likely to attract controversy. Nowadays budgets generate blanket coverage for the first 24 hours, with one element rolling on as a story until at least the weekend.
John Bruton is on record as saying that he never anticipated that VAT on children's shoes would cause such controversy as to precipitate the collapse of a government. Charlie McCreevy probably never foresaw the storms occasioned by tax individualisation or additional charges on credit unions.
When it comes to post-budget media cycles, the devil is either in the detail or the quality of post-budget media strategy.
Yet, if Brian Lenihan had got time last Monday to list the political grenades he was due to unpin the next day then abolishing the automatic entitlement of the over-70s to a medical card would have topped the list on explosive potential.
In taking this step the Government is doing something politicians seldom have the courage to do, namely, removing an existing entitlement.
The Government is also reversing a bad decision which some of them, as members of Cabinet in December 2000, were involved in making.
In the 2001 budget speech delivered that month McCreevy announced the extension of the free medical card scheme to all persons over 70 irrespective of income or whether they had a long-term illness.
Extending universal free medical care to all over 70 was wrong even when the public finances were in surplus because it meant that health funding which should be targeted at those most in need was diverted to pay for primary medical care for a group selected purely on the basis of age, many of whom could afford their own healthcare or health insurance.
However, the policy mistake was compounded by the manner in which it was implemented.
The decision to announce the free medical cards in the budget speech itself was rushed, leaving officials insufficient time to assess adequately the numbers entitled and the overall cost.
The government also backed itself into a political alley by announcing the initiative without first negotiating its terms. This left the taxpayer open to being easily mugged by the medical profession who could negotiate a capitation rate for the over-70s who didn't already have a medical card which was four times greater than that for other patients.
The loudest critics of the initiative in 2001 were the Irish Medical Council - whose GP committee was then chaired by Dr James O'Reilly, now Fine Gael's health spokesman - and Labour's then health spokeswoman Liz McManus.
Of course, the introduction of free medical cards for over-70s was done with an eye to the 2002 election, and Fianna Fáil cited it as one of its most important achievements in campaign literature aimed at older voters.
It is also true that the exorbitant cost of the scheme was invariably included in lists of items deemed a waste of public money rolled out by Fine Gael and Labour prior to the 2007 election.
However, if an earlier Fianna Fáil-led government deserved criticism for the initial mistake then the current Fianna Fáil-led Government is due credit for reversing it.
Somewhat inevitably, given that the Department of Health and the Health Service Executive were involved, the announcement has not gone smoothly.
Those responsible for rolling out the detail of the proposal failed to appreciate that while only about a third of those currently on the over-70s medical card will have it withdrawn, the fear of losing the medical card extended to everyone over 70.
Some 350,000 people aged over 70 have medical cards. Some 211,000 of these already had a medical card before turning 70, suggesting they already qualified under either means test or long-term illness criteria, and will not, therefore, lose their card.
Of the remaining 140,000, a large percentage will be entitled to the new GP-only medical card and a further percentage will receive the new €400 medical assistance grant. Most of those concerned about being exposed to inordinate medical costs have no real reason to worry.
Confusion on Wednesday and Thursday about the cut-off point for entitlement didn't help.
Neither did the fact that, like all coverage of health-policy issues, much of the reportage focused on individual stories.
It can be difficult to communicate changes to a health entitlement but it becomes almost impossible when a politician or health official has to compete in the same news package or phone-in with an individual who says he or she will suffer particular hardship when the universal entitlement is abolished.
It would be interesting if next January the reporters who compiled these packages were to revisit each of those patients featured. There is at least a two to one chance that they will not have had their medical card removed.
This week Fianna Fáil deputies - both new and old - got a real sense of what its like to be a Government backbencher in recessionary times.
Apparently, Rory O'Hanlon TD - a man who knows a thing or two about the pressure involved in implementing health cuts - made a strong appeal to his younger colleagues this week to show some backbone. They would be wise to heed his advice.